CULTURE AND PSYCHOPATHOLOGY

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CULTURE AND PSYCHOPATHOLOGY

• PSYC 338

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Case Study
Mr. and Mrs. Gomes, a first-generation Portuguese
American couple brought their 20-month-old son
John to the developmental-behavioural clinic
because of his refusal of food, inadequate weight
gain and poor sleeping patterns. Mrs. Gomes and
her mother had taken to feeding John all day
long, following him around with food and a spoon
as he played. John looked thin, pale and weak to
his mother and grandmother and that image was
reinforced by neighbors and relatives. Sleep
subsequently emerged as a problem within a week
of the Gomess moving form the maternal
grandparents home to their own place where they
had lived the first 9 months. What do you need to
consider when helping the family?
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• Culture permeates all aspects of
• Psychopathology
• Experience
• Expression
• Explanation
• Assessment
• Treatment

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Culture and Psychopathology

• Whats normal and abnormal ?
• Expression of Abnormal Behavior
• Assessment and Diagnosis of Abnormal Behavior
• Explanations of Psychopathology
• Treatment

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Whats normal? Mental illness in a Laotian
village

• Dangerous behavior
• Disruptive and dysfunctional activities
• Communication problems
• Delusions
• Inappropriate affect
• Somatic symptoms

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Case Studies
A Pakistani patient complains of pain and
weakness I have pains in my head, I have a
body ache I have lost all of my
strength Whats your diagnosis?
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Expression of Abnormal Behavior

• Symptoms of depression as an affective
  disorder
• Affect- depressed mood
• Behavior- withdrawn
• Cognitive- guilt, worthlessness
• Somatic complaints
• Is depression manifest the same way across
  cultures?

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Studies of Depression

• Kleinmanns study in Taiwan
• 88 complained of somatic symptoms
• 40 never admitted to depressed affect
• 28 rejected the notion they were
  depressed
• Cross-cultural study (Ulusahin et al., 1994)
• Turkish patients had higher scores for somatic
  complaints
• British patients had higher scores for core
  psychological complaints
• Matsumotos cross-cultural study
• Americans experiences more intense emotions for a
  longer duration than Japanese

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Feelings of Guilt
Guilt-based societies I have done something
wrong, and even if it is never discovered and
nobody else but me knows about it, I am
distressed and disgusted with myself. Shame-base
d societies I have done something wrong in the
eyes of other people. People who matter to me are
disgusted with my behaviour, and therefore I am
distressed because I cannot face them.
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Assessment and Psychological Testing

• Chinese Personality Assessment Inventory
• Mental disorders are caused by malfunction
• of the vital organs (SOM)
• I have to hide my homosexual orientation
  (SM)
• I feel indebted to people around me. (DEP)

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Assessment and Psychological Testing

• American Indian Depression Scale
• Worry sickness
• Unhappiness
• Heart-broken
• Drunken-like craziness
• Disappointment

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Explanations of Psychopathology

• Biological
• Psychological
• Social
• Spiritual
• Ecological

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Treatment of Psychopathology

• Importance of matching treatment with
  explanation
• Similarity of process across therapeutic
  approaches

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MODELS OF PSYCHOPATHOLOGY

• UNIVERSAL MODELS AND CULTURE-BOUND SYNDROMES

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Models of culture and pathology

• Psychopathology as universal
• Psychopathology as culturally constructed
• Hybrid orientation to psychopathology

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Assumptions of the Universal Perspective

• Abnormal behaviors occur across cultures
• Principal categories of psychopathology occur
  world-wide
• Incidence and prevalence of disorders in
  diagnostic categories vary little across
  cultures
• Manifestation of various disorders are
  similar

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Standardized Diagnostic Systems

• International Classification of Disorders
  (ICD-10)
• Diagnostic and Statistical Manual of Mental
  Disorders (DSM-IV)

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Empirical Research

• Affective Disorders
• Schizophrenia
• Childhood Disorders
• Suicide
• Alcoholism
• Anxiety Disorders
• Personality Disorders

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WHO study of affective disorders

• Schedule for Standardized Assessment of
  Depressive Disorders
• Switzerland, Canada, Japan, Iran
• Core symptoms present in 76 of cases
• Cultural variations in some symptoms and in the
  expression of depression

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Schizophrenia

• WHO pilot study
• Two year follow-up
• WHO prospective study

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Pilot Study

• 1200 patients in 9 countries
• Nigeria, India, Taiwan, Czech Republic, Denmark,
  Russia, U.K., Columbia, U.S.
• Core symptoms

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Two year follow-up

• 75 of original patients
• Most positive symptoms absent
• Cultural variation in negative symptoms
• Cultural variation in prognosis
• Cultural variation in predictors

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Prospective Study

• 1300 patients in 10 countries
• Incidence of functional psychosis comparable
  across cultures
• More acute onset in developing countries

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Childhood Disorders

• Reactions to temperament differ
• Diagnosis of hyperactive and disruptive
  behaviours of children appears to be culturally
  variable function of the nationality of both the
  child and the diagnostician
• Childhood Behaviour Checklist

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Culture Specific Idioms of Disease

• Ataque de nervios
• Nervios
• Rootwork
• Susto

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Culture Bound Syndromes

• Amok
• Koro
• Latah
• Anorexia nervosa

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Does the DSM-IV provide an adequate
classification scheme for mental disorders?